Workers’ Compensation
Workers’ Comp Request Form
Use this form to request workers’ comp coverage for a placement. Tell us the state, the job, and what the person will actually be doing. We match it to the right class code and confirm coverage in writing before anyone starts.
BOSS Workers’ Comp Request Form
When to submit one
Four signals you need a request
Coverage is not one blanket policy. It is priced and approved state by state and code by code. Your rate calculator is the quickest way to tell where you already stand.
It is not in your calculator
If a state or a class code does not appear in your rate calculator, we are not bound for it. That absence is your signal to send a request before you quote the client.
A new job class
Duties drive the code, not the job title. A different role at the same client can land in a different class with a very different rate.
A new client or worksite
Where the work happens and who supervises it both matter. A warehouse floor and a corporate office are not the same risk.
We ask you for one
Sometimes our team will request the form directly, usually when a duty description or a worksite needs a closer look. If you get that ask, send it back before the start date.
Before you start
What to have ready
Every field on the form matters, but these are the ones that decide the outcome. Gather them once and the request goes through on the first pass.
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Client and worksiteLegal name of the client company and the physical address where the work is performed.
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State of employmentEvery state the employee will work in, including travel between sites.
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Job title and dutiesA plain description of the actual work. Not the job board headline.
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Class code, if you have oneInclude it if the client already uses one. We will confirm it or correct it.
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Headcount and hoursHow many people you expect to place and the hours per week for each.
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Pay rate and estimated payrollHourly or salary rate, plus the estimated payroll for the full assignment.
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Start dateWhen the first employee is expected on site.
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Anything unusualHeights, machinery, driving, hazardous materials, overnight travel. Flag it now rather than after a claim.
How it works
From request to confirmation
Four steps, in order. Nothing here needs a portal login or a phone call.
Download and complete
Fill in every field. A thin duty description is the most common reason a request comes back for more detail.
Send it in
Email the completed form to sales@backofficenow.com and put the client name in the subject line.
We review the class code
Our team matches the duties to the correct code and checks it against carrier eligibility for that state.
We confirm coverage and your rate
You get a straight answer on whether the placement can be covered, and the specific workers’ comp rate that applies to it, before you quote the client.
Check the prohibited codes first
Some class codes cannot be written under our program at any rate. Reviewing the prohibited codes list before you submit saves you a round trip, and saves you from quoting a client on work we cannot cover.
Questions
Common questions
Do I need a separate form for each state?
Yes. Workers’ comp is regulated and priced state by state, so an approval in one state tells you nothing about the next one. If a single placement crosses state lines, note every state on the same form and we will handle it together.
What if I do not know the class code?
Leave it blank and spend the time on the duty description instead. Assigning the code is our job, and a detailed description of the work gets you a more accurate answer than a guessed code does.
How far ahead should I submit?
Before you confirm the placement with your client. Approval is not automatic, and walking back an offer because the class turned out to be ineligible is a conversation worth avoiding.
Does this replace a certificate of insurance?
No. This form requests coverage. A certificate is proof that coverage already exists. If your client is asking for a certificate for an active placement, request that separately.
What happens if the duties change after approval?
Send a new form. Coverage follows the duties we approved, so a real change in the work can move the class code and the rate. Telling us early is far cheaper than discovering it during a claim.
Not sure if your placement needs one?
Send us the job description. We will tell you whether it is coverable, what the class code looks like, and what it does to your bill rate, before you quote the client.